<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Citylist')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-citylist" data-rule="required" class="form-control" name="row[citylist]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-address" class="form-control" name="row[address]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Sale')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-sale" class="form-control" name="row[sale]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Tech')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-tech" class="form-control" name="row[tech]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Mail')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mail" class="form-control" name="row[mail]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fax')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fax" class="form-control" name="row[fax]" type="text">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
